Medical laser device and related methods

ABSTRACT

A laser delivery device may include a connector portion at a proximal end of the laser delivery device and an optical fiber connecting the connector portion to a distal end of the laser delivery device. The connector portion may include a capillary at least partially surrounding a proximal portion of the optical fiber, and the capillary may include dimples on at least a portion of a circumferential surface thereof.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/729,718, filed Oct. 11, 2017, which claims the benefit of priority ofU.S. Provisional Application Nos. 62/406,706, filed Oct. 11, 2016, and62/445,770, filed Jan. 13, 2017, the entireties of which areincorporated by reference into this application.

TECHNICAL FIELD

Various aspects of the present disclosure relate generally to medicallaser devices and related methods. More specifically, the presentdisclosure relates to medical laser devices and connectors fortransmitting select modes of laser energy through a fiber.

BACKGROUND

Lasers have been used in, for example, urology, neurology,otorhinolaryngology, general anesthetic ophthalmology, dentistry,gastroenterology, cardiology, gynecology, thoracic, and orthopedicprocedures. One example of a procedure that may be performed using alaser is lithotripsy. Lithotripsy involves treating a subject's kidneys,ureters, or bladder by removing material therein, such as calculi orstones. Laser lithotripsy is a subset of lithotripsy where laser energyis applied to break down targeted material, thereby facilitating removalof the material. In one exemplary laser lithotripsy procedure, anoptical fiber may be inserted through a working channel of an insertiondevice, such as an endoscope or a ureteroscope, and adjacent to thetargeted material. The optical fiber may transmit laser energy to thetargeted material to break down the targeted material into pieces. Thepieces may then be washed out of, or otherwise removed from, thesubject.

However, often in laser lithotripsy, the size of the optical fiber inthe laser delivery device limits the power of the laser that can bedelivered to the targeted material, thus limiting the ability to breakdown the material. A powerful laser emits higher order laser energy thatmay escape an optical fiber and be absorbed by components in a handle ofthe laser delivery device, heating those components to unsafetemperatures and posing a risk to a user. A powerful laser may alsooverheat the optical fiber, which may break the optical fiber or burn asubject.

The devices and methods of the current disclosure may rectify some ofthe deficiencies described above, or address other aspects of the priorart.

SUMMARY

Examples of the present disclosure relate to, among other things,medical laser devices. Each of the examples disclosed herein may includeone or more of the features described in connection with any of theother disclosed examples.

In one example, a laser delivery device may include a connector portionat a proximal end of the laser delivery device, and an optical fiberconnecting the connector portion to a distal end of the laser deliverydevice. The connector portion may including a capillary at leastpartially surrounding a proximal portion of the optical fiber, whereinthe capillary includes dimples on at least a portion of acircumferential surface thereof.

The laser delivery device may further include one or more of thefollowing features. The dimples may be included on an outercircumferential surface thereof. The dimples may be arranged in apattern. The dimples may be arranged randomly. The capillary may beglass. The dimples may be a constant depth, or the dimples may bevarying depths. The dimples may be formed by melting with a CO₂ laser.The dimples may be not included on a distal outer circumferentialsurface portion of the capillary. An outer circumferential surface ofthe capillary also includes projections. The optical fiber may include acore surrounded by at least one cladding layer and/or one buffer layer;and the optical fiber may be at least partially surrounded by a jacketlayer. The capillary may include a dimple free portion at a proximal endof the capillary and may be fused to the optical fiber at proximal endsof the capillary and the optical fiber. At least a portion of thecapillary may be radially surrounded by a stainless steel ferrule. Aportion of the capillary may be surrounded by a crimp, and the opticalfiber may pass through the crimp. The laser delivery device may becoupled to a holmium laser.

In another example, a laser delivery device may include an SMAconnector. The SMA connector may include a capillary at least partiallysurrounding a portion of an optical fiber, and the capillary may includedimples on at least a portion of a circumferential surface thereof.

The laser delivery device may further include one or more of thefollowing features. The optical fiber may be fused to the capillary atleast over a portion of the optical fiber. The dimples may be includedon an outer circumferential surface of the capillary.

In another example, a laser delivery device may include a connectorportion at a proximal end of the laser delivery device, and an opticalfiber connecting the connector portion to a distal end of the laserdelivery device. The connector portion may include a capillary at leastpartially surrounding a proximal portion of the optical fiber, and thecapillary may include a dimple free portion at a proximal most end and adimpled portion.

The laser delivery device may further include one or more of thefollowing features. The capillary may be fused to the optical fiber overthe overlap of the dimple free portion with the optical fiber. Thedimpled portion may include dimples on an outer circumferential surfaceof the capillary. The dimples on the dimpled portion of the outercircumferential surface of the capillary may be formed by melting with aCO₂ laser.

Both the foregoing general description and the following detaileddescription are exemplary and explanatory only and are not restrictiveof the features, as claimed. As used herein, the terms “comprises,”“comprising,” or other variations thereof, are intended to cover anon-exclusive inclusion such that a process, method, article, orapparatus that comprises a list of elements does not include only thoseelements, but may include other elements not expressly listed orinherent to such a process, method, article, or apparatus. Additionally,the term “exemplary” is used herein in the sense of “example,” ratherthan “ideal.” As used herein, the terms “about,” “substantially,” and“approximately,” indicate a range of values within +/−5% of a statedvalue.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate exemplary features of the presentdisclosure and together with the description, serve to explain theprinciples of the disclosure.

FIG. 1 illustrates an exemplary medical laser delivery device;

FIG. 2 illustrates a cross-section of a portion of the medical laserdelivery device of FIG. 1 coupled to a laser source;

FIG. 3 illustrates a cross-section of a portion of the medical laserdelivery device of FIG. 1;

FIG. 4 illustrates a perspective view of a dimpled capillary of theexemplary medical laser delivery device;

FIG. 5 illustrates a cross-section of a portion of a medical laserdelivery device according to another aspect of this disclosure;

FIG. 6 illustrates a schematic view of an exemplary method of forming adimpled capillary of the medical laser delivery device of FIG. 5; and

FIG. 7 illustrates a perspective view of the dimpled capillary duringthe method of FIG. 6.

DETAILED DESCRIPTION

Examples of the present disclosure relate to medical devices fordelivering laser energy to target tissue or material. The medical devicemay be delivered through any appropriate insertion device or alonethrough a bodily orifice.

Reference will now be made in detail to examples of the presentdisclosure described above and illustrated in the accompanying drawings.Wherever possible, the same reference numbers will be used throughoutthe drawings to refer to the same or like parts.

The terms “proximal” and “distal” are used herein to refer to therelative positions of the components of an exemplary medical device orinsertion device. When used herein, “proximal” refers to a positionrelatively closer to the exterior of the body or closer to an operatorusing the medical device or insertion device. In contrast, “distal”refers to a position relatively further away from the operator using themedical device or insertion device, or closer to the interior of thebody.

FIG. 1 illustrates a laser delivery device 10 with a proximal portion12, an intermediate portion 14, and a distal portion 16 with a distaltip 17. Proximal portion 12 may include a handle 18 having a connectorportion 20. Laser delivery device 10 may couple to a laser source 22 viaconnector portion 20 and transmit energy through an internal fiber inlaser delivery device 10 and out of distal tip 17 to targeted material.

FIG. 2 illustrates proximal portion 12 of laser delivery device 10 withconnector portion 20 mated to laser source 22. Laser delivery device 10may receive laser energy 24 from the laser source 22 to be deliveredthrough an optical fiber 26 that extends through the laser deliverydevice 10 to the distal tip 17 at distal portion 16. A portion ofoptical fiber 26 within connector portion 20 may be at least partiallysurrounded by a capillary 28, which as will be discussed in more detailbelow may be dimpled to scatter incident light.

Laser source 22 may include a lens 30 to narrow the laser energy 24, andmay also include a port 32 extending from laser housing 34 to receiveand mate with connector portion 20 of laser delivery device 10 in orderto transmit laser energy 24 through laser delivery device 10. Lasersource 22 may be, for example, a holmium YAG (Ho:YAG) laser sourceemitting laser energy 24 with a wavelength of approximately 2.1 μm and apower of approximately 100 W. Laser source 22 may generate laser energy24 with a shallow penetration depth of approximately 0.4 mm. In otheraspects, laser source 22 may be a Thulium-doped YAG (Tm:YAG) lasersource, a Thulium Fiber laser source, a neodymium-doped YAG (Nd:YAG)laser source, a semiconductor laser diode, an Erbium-doped YAG (ER:YAG)laser source, or a frequency doubled Nd:YAG laser source utilizingeither a potassium-titanyl phosphate crystal (KTP), or a Lithium Boratecrystal (LBO) as the doubling crystal. Though not shown, laser source 22may have a control module to control a timing, a wavelength, and/or apower of the laser energy 24. The control module may control laserselection, filtering, temperature compensation, and/or Q-switching.

As noted above, laser delivery device 10 may mate with laser source 22through connector portion 20. Connector portion 20 may include opticalfiber 26 and capillary or tube 28 radially surrounding a proximalportion of the optical fiber 26. Connector portion 20 may furtherinclude a ferrule 36 radially surrounding at least a portion of opticalfiber 26 and capillary 28. There may be a circumferential hollow portion38 or gap between a portion of ferrule 36 and a portion of capillary 28.Optical fiber 26 may extend through laser delivery device 10 from theconnector portion 20 to the distal tip 17 to receive and transmit laserenergy 24 from laser source 22 to targeted material. Capillary 28include a dimpled outer surface to scatter incident laser energy 24 thatescapes optical fiber 26. Capillary 28 may be fused to optical fiber 26at least over a portion of their overlap (FIG. 2), for example at theproximal ends of optical fiber 26 and capillary 28. In one aspect, whereoptical fiber 26 is fused to capillary 28, optical fiber 26 onlyincludes a fiber core and is not enclosed by buffer layers or jacketlayers. Fiber core of optical fiber 26 may be fused to capillary 28 atthe proximal ends of optical fiber 26 and capillary 28. Alternatively,fiber core of optical fiber 26 may be fused to capillary 28 for over thelength of the capillary 28 that radially surrounds optical fiber 26.More distal portions of optical fiber 26 may be enclosed by variousother layers. Ferrule 36 may include radial projections such that it maybe coupled to handle 18.

Connector portion 20, along with ferrule 36 and the enclosed components,may be any type of SubMiniature version A (“SMA”) connector or anotherappropriate optical fiber connector to mate with port 32. Connectorportion 20 may include a central fiber to receive and transmit laserenergy 24 from laser source 22, and may also include an outer threadingin order to be coupled to port 32. For example, connector portion 20 maybe a male SMA connector if port 32 is a female SMA connector, orconnector portion 20 may be a female SMA connector if port 32 is a maleSMA connector. Ferrule 36 may be stainless steel or another appropriatematerial. A crimp 40 may also radially surround a portion of opticalfiber 26 and a portion of capillary 28. Crimp 40 may have a cup-likeshape in a proximal portion where it surrounds both optical fiber 26 andcapillary 28, and may extend longitudinally in a distal directionsurrounding the optical fiber 26. Crimp 40 may be brass, aluminum, oranother appropriate material. Capillary 28, ferrule 36, and crimp 40 maybe coupled via glue, epoxy, or another appropriate adhesive.

As shown in FIG. 3, capillary 28 may surround optical fiber 26 and maybe proximally flush with a proximal end of ferrule 36. Optical fiber 26may be slightly recessed within capillary 28. Optical fiber 26 may passthrough a longitudinal core of laser delivery device 10, as shown inFIGS. 1 and 2. Optical fiber 26 may extend the length of laser deliverydevice 10 to receive laser energy 24 at the junction of connectorportion 20 with laser source 22 and to deliver laser energy 24 to thetargeted material from distal tip 17 at the distal portion 16 of laserdelivery device 10.

Optical fiber 26 may have a circular cross-section and may comprise afiber core surrounded by one or more cladding layers (not shown), whichmay also be surrounded by one or more buffer layers (not shown).Distally beyond capillary 28, optical fiber 26 may be surrounded by oneor more jacket layers 44 through crimp 40 and to distal portion 16 oflaser delivery device 10. Jacket layers 44 may be bonded to crimp 40through an adhesive or may be joined by crimp 40 pinching jacket layers44 around optical fiber 26. Optical fiber 26 may be a silica-basedoptical fiber. The core of optical fiber 26 may be made of a suitablematerial to transmit laser energy 24, such as, for example, silica withlow hydroxyl (OH⁻) ion residual concentration. Like the core of theoptical fiber 24, the one or more cladding layers may be pure silica ordoped silica with, for example, fluorine. The one or more claddinglayers may be a single or double cladding, and may be made of a hardpolymer or silica. The one or more buffer layers may be an acrylatelayer or may be made of a hard polymer, such as, for example, Tefzel®.

The distal tip 17 of laser delivery device 10 may be a spherical end, astraight-firing end, a side-firing end, or another appropriate end. Thedistal tip 17 of laser delivery device 10 emits the laser energy 24toward the targeted material, so optical fiber 26 serves as a waveguidefor laser energy 24.

As shown in FIG. 4, capillary 28 may be a hollow tube with dimples 42.Capillary 28 radially surrounds optical fiber 26 within connectorportion 20 and is partially surrounded by crimp 40 (FIGS. 2 and 3). Thehollow portion or lumen within capillary 28 may widen at the proximalend and distal end of capillary 28. Capillary 28 may be formed of glass,silica, sapphire, or another appropriate material.

The dimples 42 may be located on the outer circumferential surface ofcapillary 28 to scatter overfilled laser energy 24 or higher order modelaser energy 24 that escapes from optical fiber 26 toward ferrule 36, asshown in the lines of laser energy 24 in FIG. 3. The dimples 42 oncapillary 28 may have equal sizes and depths and be evenly spaced aroundthe entire outer radial surface and length of capillary 28 (FIG. 4). Inan alternative aspect, dimples 42 may only be distributed over a portionof the outer radial surface of capillary 28, namely only over thatportion of capillary 28 that is exposed to hollow portion 38 (FIG. 3).In another aspect, dimples 42 may be distributed over even less of thecircumferential surface of the capillary 28. Dimples 42 may also bedistributed over all or a portion of both the inner and outercircumferential surfaces of the capillary 28.

Dimples 42 may be depressions, indentations, hollows, bubbles, notches,frostings, or perforations. Dimples 42 may be spherical, elliptical, oranother shape. Dimples 42 may partially extend through the radialthickness of capillary 28, and may be constant or varying depths. In oneaspect, dimples 42 may extend between 1 and 50 micrometers through theradial thickness of capillary 28. Alternatively, outer and/or innercircumferential surface of capillary 28 may include bumps (not shown),or a combination of dimples 42 and bumps. Moreover, dimples 42 or bumpsmay be arranged in capillary 28 in a pattern (as shown) or randomlypositioned, and may be evenly spaced or unevenly spaced. Furthermore,capillary 28 may include a plurality of internally dispersed particlesto scatter the higher order mode or overfilled portions of laser energy24.

Dimples 42 may be formed in or on capillary 28 by melting specific spotswith a CO₂ laser or a green light laser. Dimples 42 may be formed in oron capillary 28 through a mechanical or chemical etching process.Dimples 42 may be preformed in capillary 28, or may otherwise be formedin capillary 28.

During use, laser delivery device 10 may be inserted in an alreadypositioned insertion device, such as a ureteroscope or an endoscope.Handle 18 may then be connected to laser source 22 via connector portion20 and port 32 (FIG. 2). Once activated, laser source 22 provides laserenergy 24 to laser delivery device 10, with the laser energy 24propagating through optical fiber 26 to be applied to the targetedmaterial. Higher order mode and overfilled portions of laser energy 24may escape optical fiber 26 and enter capillary 28 within the first fewmillimeters of the connector portion 20 from port 32, as shown in FIG.3.

The higher order mode and overfilled portions of laser energy 24, whichheat up components when absorbed, have a tendency to refract and bouncewithin connector portion 20 and optical fiber 26. However, dimples 42 onthe outer radial surface of capillary 28 may assist in scattering someof the higher order mode and overfilled portions of laser energy 24 andthus reduce the amount of stray energy downstream of the capillary 28.An increase in or greater distribution of dimples 42 on capillary 28 mayscatter a greater portion of the higher order mode and overfilledportions of laser energy 24 and thus further assist in reducing thedetrimental effects downstream of the capillary 28. The scattering ofthe higher order mode and overfilled portions of laser energy 24 by thedimples 42 of capillary 28 may be absorbed by the proximal portion offerrule 36, as shown in FIG. 3. However, heating up this portion of thelaser delivery device 10 is preferred over allowing this stray orrefracted energy to travel downstream of the capillary 28. The ferrule36 is better suited to absorb scattered portions of laser energy 24 andundergo the accompanying increase in temperature than more distalcomponents of laser delivery device 10. Further, ferrule 36 and itsconnections may be insulated from other fragile and/or heat-sensitivecomponents in laser delivery device 10 allowing the ferrule 36 to be abetter heat sink. Ferrule 36 and its connections may also be insulatedfrom the outer surface of handle 18 and other components that a user maycontact during operation, reducing the risk of injury to the user, evenwhen using a high powered laser source 22. Restated, the dimples 42 helpto isolate the detrimental effects of the higher order mode andoverfilled portions of laser energy 24 to a portion of the laserdelivery device 10 that is better suited to handle the higher order modeand overfilled portions of laser energy 24.

Additionally, the reduction in higher order mode and overfilled portionsof laser energy 24 downstream of the capillary 28 due to dimples 42makes it more likely that the laser energy 24 will be internallyreflected within optical fiber 26 until it reaches the targetedmaterial, as shown in FIG. 3. Therefore, including dimples 42 oncapillary 28 reduces the risk of the optical fiber 26 and connectorportion 20 overheating, even with a powerful laser source 22 like aholmium laser and even at susceptible portions of the optical fiber 26like bends. Reducing the risk of the optical fiber 26 overheatingreduces the risk of the optical fiber 26 breaking and/or burning asubject. As such, a more powerful laser source may be used with laserdelivery device 10, allowing for quicker and more effective procedureson targeted material.

As shown in FIG. 5, which is an alternative example with similarelements to the laser delivery device 10 shown by 100 added to thereference numbers, the laser delivery device includes a connectorportion 120 that receives laser energy 124. The laser delivery devicealso includes optical fiber 126, capillary 128, ferrule 136, crimp 140,and jacket layer 144.

In this aspect, capillary 128 includes dimples 142 on a dimpled portion146, and also includes a dimple free portion 148 at a proximal end ofcapillary 128. Capillary 128 may surround optical fiber 126, andcapillary 128 may be fused to optical fiber 126 over the overlap of thedimple free portion 148 with the optical fiber 126 to form a fusedportion 149. Then, connector portion 120 of the laser delivery devicemay be used to deliver laser energy 124 to target tissue or material.Fused portion 149 ensures that capillary 128 is bonded to optical fiber126, and the dimples 142 on dimpled portion 146 scatter some of thehigher order mode and overfilled portions of laser energy 124.

In one aspect, capillary 128 may have a total length of approximately 20mm, and dimple free portion 148 may be approximately 2.5 to 5 mm and mayextend from the proximal most end of capillary 128. Fused portion 149may have the same length as dimple free portion 148, or the dimple freeportion 148 may extend distal to the fused portion 149. In otheraspects, capillary 128 may be longer or shorter, and dimple free portion148 may be approximately 10-30% of the total length of the capillary128. Dimpled portion 146 may make up the remaining portion of capillary128, or may be less than all of the remaining portion of capillary 128.For example dimples 142 may terminate prior to the distal most end ofthe capillary 128.

Dimples 142 may be depressions, indentations, hollows, bubbles, notches,frostings, or perforations. Dimples 142 may be formed in or on a dimpledportion 146 of capillary 128 by laser etching, such as, for example, bymelting specific spots with a CO₂ laser or a green light laser. Dimples142 may alternatively be formed in or on dimpled portion 146 ofcapillary 128 by mechanical etching, such as, for example, sandblasting. Dimples 142 may also be formed in or on dimpled portion 146 ofcapillary 128 by chemical etching, such as, for example, with ahydrofluoric acid solution.

FIGS. 6 and 7 provide an exemplary method of making capillary 128. Forexample, a plurality of capillaries 128 with dimples 142 may be formedand fused to optical fibers 126 according to method 200. In step 202, along capillary tube 150 may be attached on a mounting (not shown), andlaser beam 152 may be directed at the capillary tube 150. Laser beam 152may be a pulsed CO₂ laser beam. In step 204, the laser beam 152 may beactivated, and the capillary tube 150 may be rotated around its axis indirection 154 by the mounting so as to form dimples 142 in the outercircumference of capillary tube 150. The mounting may also move thecapillary tube 150 longitudinally along direction 156 relative to laserbeam 152 to dimple the outer circumference of capillary tube 150 to formdimpled portion 146. In step 206, the laser beam 152 may be deactivatedor turned off momentarily while the mounting moves capillary tube 150axially, and then the laser beam 152 may be activated or turned onagain. In step 208, the deactivation and reactivation steps may berepeated as the laser beam 152 forms a series of dimpled portions 146and dimple free portions 148 over the length of capillary tube 150.

Then, in step 210, laser beam 152, which may be adjusted to be aconstant laser beam, may be applied to the capillary tube 150 proximateto an interface 158 of one of the dimpled portions 146 and one of thedimple free portions 148. The mounting may halt any axial movement butmay rotate in direction 154 to rotate the capillary tube 150 so thelaser beam radially cuts capillary tube 150. The laser beam 152 may beapplied such that the capillary tube 150 is cut into a plurality ofcapillaries 128, each having a dimpled portion 146 and a dimple freeportion 148. Each capillary 128 may then be used in one laser deliverydevice 10. Alternatively, the dimpling and cutting steps may be carriedout with the capillary tube 150 axially and/or rotationally stationary,and laser beam 152 moving axially and/or rotationally relative tocapillary tube 150.

In step 212, capillary 128 may be fused to optical fiber 126. Forexample, capillary 128 may be positioned over optical fiber 126 suchthat optical fiber 126 passes through a hollow portion or lumen ofcapillary 128. Optical fiber 126 may be approximately flush with orslightly distal to the proximal end of capillary 128. Once positioned,capillary 128 may be fused to optical fiber 126 over the overlap of thedimple free portion 148 with the optical fiber 126 to form fused portion149. Fusion may be accomplished by applying laser energy, which may bethe laser beam 152, around the radial circumference of the overlap. Aswith the dimple formation step, the capillary 128 and optical fiber 126may be rotated relative to the source of laser energy. Alternatively,the capillary 128 and optical fiber 126 may be stationary with thesource of laser energy being rotated.

In a non-illustrated example, capillary tube 150 may be radially cutthrough a dimple free portion 148, rather than at interface 158. Assuch, the formed capillary 128 may include dimple free portion 148 at aproximal end, as well as a second dimple free portion at a distal end.In one aspect, capillary tube 150 may be approximately 1 meter, and maybe dimpled and cut into a plurality of even or uneven capillaries 128.

The fused capillary 128 and optical fiber 126 may be implemented inlaser delivery device 10 as discussed above with respect to capillary 28and optical fiber 26 in laser delivery device 10 such that dimples 142on dimpled portion 146 scatter the higher order mode and overfilledportions of laser energy 124. Similarly, capillary 128 with dimpledportion 146 around optical fiber 126 increases the likelihood that laserenergy 124 will be internally reflected within optical fiber 126 untilthe energy reaches the targeted material, as shown in FIGS. 3 and 5.Dimple free portion 148 assists a user or assembler in viewing theoptical fiber 126 within capillary 128 during positioning before fusingthe elements together. Further, dimple free portion 148 in capillary 128facilitates fusing of capillary 128 to optical fiber 126 by reducinginterference of the laser energy by dimples 142 during the fusionprocess. Moreover, the method of forming a plurality of capillaries 128from long capillary tube 150 illustrated in FIGS. 6 and 7 provides aquicker, less expensive, and more efficient procedure to formcapillaries 128.

While principles of the present disclosure are described herein withreference to illustrative examples for particular applications, itshould be understood that the disclosure is not limited thereto. Thosehaving ordinary skill in the art and access to the teachings providedherein will recognize additional modifications, applications,embodiments, and substitution of equivalents all fall within the scopeof the features described herein. Accordingly, the claimed features arenot to be considered as limited by the foregoing description.

We claim:
 1. A laser delivery device, comprising: an optical fiber,including a proximal portion configured to be coupled to an energysource and a distal portion opposite the proximal portion; and acapillary surrounding at least a portion of the optical fiber andincluding a proximal portion and a distal portion, wherein the capillaryincludes a dimpled portion and a dimple free portion, wherein the dimplefree portion is at the proximal portion of the capillary, and whereinthe capillary is fused to the optical fiber over at least a portion ofan overlap of the dimple free portion of the capillary and the opticalfiber.
 2. The laser delivery device of claim 1, wherein the capillary isformed of glass.
 3. The laser delivery device of claim 1, wherein thedimpled portion includes a plurality of circular dimples on at least aportion of an outer circumferential surface thereof.
 4. The laserdelivery device of claim 3, wherein the dimples are not included on theouter circumferential surface of the distal portion of the capillary. 5.The laser delivery device of claim 3, wherein a portion of the outercircumferential surface of the capillary includes projections.
 6. Thelaser delivery device of claim 3, wherein the dimples are formed bymelting with a CO₂ laser in a pulsed mode, and wherein the dimple freeportion of the capillary is fused to the proximal end of the opticalfiber with the CO₂ laser.
 7. The laser delivery device of claim 1,wherein the proximal portion of the optical fiber is configured to becoupled to a laser source.
 8. The laser delivery device of claim 7,wherein the proximal portion of the optical fiber is configured to becoupled to a holmium laser.
 9. A laser delivery device, including: anoptical fiber, including a proximal portion configured to be coupled toan energy source and a distal portion configured to emit energy; and acapillary at least partially surrounding a portion of the optical fiber,wherein the capillary includes dimples on at least a portion of acircumferential surface thereof, wherein the capillary includes aproximal portion and a distal portion, wherein the proximal portion ofthe capillary is configured to surround at least a portion of theproximal portion of the optical fiber, and wherein the capillaryincludes a dimple free portion at the proximal portion, and wherein thecapillary is fused to the optical fiber over at least a portion of anoverlap of the dimple free portion of the capillary and the opticalfiber.
 10. The laser delivery device of claim 9, wherein the dimples areincluded on an outer circumferential surface of the capillary.
 11. Thelaser delivery device of claim 9, wherein the proximal portion of theoptical fiber is configured to be coupled to a laser source to deliverylaser energy from the laser source to the distal end of the opticalfiber.
 12. An optical device, comprising: an optical fiber extendingfrom a proximal portion to a distal portion; and a capillary at leastpartially surrounding the proximal portion of the optical fiber, whereinthe capillary includes a plurality of circular dimples on at least aportion of an outer circumferential surface thereof, and wherein thecapillary includes a dimple free portion at a proximal portion of thecapillary, and wherein the capillary is fused to the optical fiber overat least a portion of an overlap of the dimple free portion of thecapillary and the optical fiber.
 13. The optical device of claim 12,wherein the dimples are circular indentations on at least a portion ofan outer circumferential surface of the capillary and extend between 1and 50 micrometers through a radial thickness of the capillary from theouter circumferential surface of the capillary.
 14. The optical deviceof claim 12, wherein the dimple free portion includes between 10 and 30percent of the capillary.
 15. The optical device of claim 12, whereinthe capillary is fused to the optical fiber over the dimple free portionof the capillary.
 16. The optical device of claim 12, wherein theproximal portion of the optical fiber is configured to be coupled to alaser source to delivery laser energy from the laser source to a distalend of the optical fiber.